Development and Validation of Food Frequency Questionnaire for Food and Nutrient Intake of Adults in Butajira, Southern Ethiopia

Background: To date, there is no culture-specific and validated Food Frequency Questionnaire (FFQ) available in Ethiopia. We developed a FFQ and evaluated its validity as compared to estimates of a food group and nutrient intakes derived from two 24-Hour Dietary Recalls (24-HRs).Method: The FFQ has a total of 89 food items. A total of 105 adults aged 20 to 65 years participated in this study. Wilcoxon- signed rank test, Spearman’s correlation, Cross-classification, kappa, and Bland-Altman analysis were used to validate food group intakes and nutrients derived from the FFQ against two 24-HRs.Results: Mean energy and macronutrient intakes obtained from the FFQ were significantly higher than those obtained from the mean of two 24-HRs. For energy and macronutrients, the correlation between two instruments ranged from 0.05 (total fat) to 0.32 (carbohydrate). Whereas, for micronutrients, it ranged from 0.1 (calcium) to 0.49 (vitamin B1). Visual inspection of the Bland-Altman plots for both energy and macronutrients shows no consistent trend across the intake values. For the majority of the food groups, no significant difference was observed in median intake of foods and nutrients between 24-HRs and the FFQ. The correlation coefficients for food groups ranged from 0.12 (egg) to 0.78 (legumes). The FFQ showed a fair classification agreement with the 24-HRs for cereals, legumes, and roots and tubers intake. A systematic trend of overestimation for roots and tubers and under estimation of beverage intakes at higher values was observed when we used FFQ.Conclusion: The FFQ is valid to assess and rank individuals in terms of intakes of most food groups according to high and low intake categories. However, estimates of roots and tuber and beverages should be interpreted with caution.